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Best Questions to Ask Payers About ICD-10 Transition Readiness

April 22, 2013

Questions to ask payers about ICD-10 readinessICD-10 Transition Payer vs. Provider

HealthcareITNews reports that the transition to ICD-10 may cause disruption for many healthcare organizations with the exception of healthcare payers.

According to HealthEdge payers consider ICD-10 implementation as a non-issue. Most payer organizations have completed ICD-10 transition already or are confidently following a plan to do so. 90 percent of a payer survey group said they will be ready for ICD10 compliance by Oct. 1, 2014. The remaining 10 percent expressed uncertainty. None admitted any inability to meet the October 2014 deadline.

While there is much faith that payers will be ready, there is little faith that health care providers will also be ready. The HealthEdge survey uncovered the provider belief that the deadline is flexible. Here are the results:

  • 28 percent said the deadline is firm
  • 33 percent said the deadline may be flexible
  • 39 percent said the deadline will most likely change

Keeping these figures in mind, it seems likely providers will not be ready. The following Q and A session is based on CMS provided data.

Questions providers should ask payers

1. What does it mean to be ICD-10 compliant?

Everyone covered by HIPAA can conduct health care transactions using ICD-10 codes.

2. Is ICD-10 a replacement for Current Procedural Terminology (CPT) coding?

No. ICD-10-PCS codes are only for hospital inpatient procedures.

3. Does ICD-10 transition apply to me even if I don’t have any Medicare claims?

Everyone covered by HIPAA must use ICD-10 as of October 2014.

4. Do state Medicaid programs need to transition to ICD-10?

Yes. Medicaid programs must comply with ICD-10.

5. What happens if I don’t switch to ICD-10?

Claims failing to use ICD-10 diagnosis and inpatient procedure codes will not be processed. That means providers will NOT get paid.

6. If I implement ICD-10 prior to October 2014, will CMS process my claims?

No. You cannot use ICD-10 until the compliance date.

7. How is the transition to ICD-10 different from annual code changes?

ICD-10 codes have a completely different structure from ICD-9. ICD-9 codes are primarily numeric with 3-5 digits. ICD-10 codes are alphanumeric and contain 3-7 characters.

8. What is the purpose of transitioning to ICD-10?

ICD-9 codes contain limited patients’ medical data. This coding system in over 30 years old and is obsolete and inconsistent with current medical practices. The transition to ICD-10 is essential to a United States health care system that can function effectively. European countries have been using this system since 1994.

9. How can providers get ready to transition to ICD-10?

For those who have begun:

  1. Plan on testing ICD-10 systems early. Start testing by:
  2. Test internal ICD-10 systems .
  3. Coordinate with payers to establish readiness.
  4. Have data management and IT teams implement the transition.

For those who have not yet started:

  1. Working with the rest of your organization, develop an implementation plan. All relevant staff needs to understand the extent of the changes.
  2. Prepare a budget that includes software upgrades, hardware costs, staff training, work flow changes and contingency planning.
  3. Find out the readiness level of your payers, billing staff, IT staff and vendors.
  4. Work with your associates on transition plans and review contracts with payers and vendors. Coordinate your ICD-10 transition plans among your business associates and evaluate payers and vendor contracts.
  5. Create a timeline with critical milestones. See for guidance.

10. What can I do to ensure financial stability during the transition?

Start saving now or set up a credit line to prevent cash flow problems that may occur during the transition.




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